智能监测和控制微创经皮肾镜取石术中肾盂内压的意义*

Intelligent monitoring and controlling renal pelvic pressure in minimally invasive percutaneous nephrolithotomy*

摘要:

介绍一种监测和控制微创经皮肾镜取石术（MPCNL）中肾盂内压（RPP）的方法，并探讨其准确性和可靠性。方法 63例肾结石患者，男41例，女22例；平均年龄（41.6±15.6）岁，结石直径（3.7± 1.1）cm。63例均在腰硬联合麻醉下行MPCNL，术中逆行置入F5输尿管导管连接有创监护仪测定肾盂出口压力。应用腔内灌注吸引压力监控平台（以下简称：平台）和可测量压力的经皮肾吸引鞘（以下简称：鞘）监控肾内压，鞘后端通过负压吸引装置及压力监测反馈装置连接至平台，平台设定肾盂内压控制值为-5 mmHg、肾盂内压警戒值为20 mmHg、肾盂内压极限值为30 mmHg。单纯灌注吸引期和灌注吸引碎石期分别给予300、400和500 ml/min流量持续灌注5 min，记录两时期肾盂出口压力和鞘所测压力。结果 63例患者均手术成功并未出现严重并发症。单纯灌注吸引期和灌注吸引碎石期在300、400和500 ml/min组的肾盂出口压力、测压吸引鞘压力与RPP控制值-5 mmHg差异均无统计学意义（P >0.05）。结论 联合具有压力反馈控制功能的灌注吸引平台和可测量压力的经皮肾吸引鞘能准确、实时地监测和控制RPP。

Abstract:

To introduce a novel technique monitoring and controlling renal pelvic pressure (RPP) in minimally invasive percutaneous nephrolithotomy (MPCNL) and investigate the reliability and stability. Methods 63 kidney stone patients, including 41 male cases and 22 female cases were enrolled in this study. The average size of stone was (3.7 ± 1.1) cm. The average age was (41.6 ± 15.6) years old. All the patients were performed MPCNL under combined spinal and epidural anesthesia. A ureteral catheter connected to an invasive blood pressure monitor was retrogradely placed to measure renal pelvic outlet pressure. They were treated by a patented intelligent system including an irrigation and suctioning platform and a pressure-measuring suctioning ureteral access sheath. On the platform, RPP control value was set at -5 mmHg, RPP warning value was set at 20 mm Hg, and RPP limit value was set at 30 mm Hg. RPP was measured at simple irrigation and suctioning period, and lithotriptic irrigation and suctioning period when Infusion flow was set at 300 ml/min, 400 ml/min, 500 ml/min for 5 min respectively. Results 63 patients were performed successfully with no serious complications. No statistical significance was found between renal pelvic outlet pressure and sheath measured pressure for 300 ml/min, 400 ml/min, 500 ml/min group at simple irrigation and suctioning period, and lithotriptic irrigation and suctioning period (P > 0.05). Conclusion The intelligent devices including platform and shealth in the MPCNL can reliably and stably monitor and control the RPP in real time within a safety range.